Sr. Director - Payer ContractingDepartment: Payer Relations & Contracting
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Michael Cotton
Compensation: $175,000 - $185,000 / year
DescriptionJob Title: Senior Director - Payer Contracting
Department: Contracting
About the Role:We are currently seeking a highly motivated Senior Director - Payer Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Orange, CA and Monterey Park, CA and at home on a weekly basis. This role will work closely with the SVP of Payer Contracting to develop and execute on managed care contracting strategies and negotiations. You will be responsible for identifying and evaluating payor and provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation and fee for service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
What You'll Do- Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
- Manages contractual relationships with payers and internal stakeholders
- Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
- Circulates draft contract terms/language to various internal departments for review & approval
- Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
- Answers and/or resolves inquiries from health plans or internal departments in a timely manner
- Establishes good working relationships with health plan representatives and internal teams
- Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
- Utilizes applicable financial tools and reports to evaluate performance of current contracts
- Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
- Ensures compliance and consistent contracting across the enterprise.
- Manages various ad-hoc project requests with short turnaround time.
- Performs other duties as assigned.
Qualifications- Master's degree and/or Bachelor's degree or BS/BA in business administration or health care related field of study or equivalent years of experience
- Direct experience leading health plan/provider negotiations
- Experience with financial models analyzing health plan agreements
- At least 10 years prior experience in contracting
You're great for this role if: - Experience in risk-based contracting and associated financial analysis strongly preferred
- Ability to close deals under tight deadlines-sense of urgency
- Comfortable in negotiating all types contracts from start to finish within defined parameters
- Experience with FFS, capitation, and risk sharing arrangements
- Experience with government programs (Medicare, Medi-Cal, D-SNP)
- Experience working with health plan, provider and hospital counterparts
- Knowledge of California payer, Institutional and IPA contracting
- Successful experience negotiating contracts for all Lines of Business (Commercial, Medicare, Medicaid, and Accountable Care)
- Project management skills/experience
- Advanced MS Word capabilities: find & replace, redlining, comment insertion, track changes and document compare
- Proficient in MS Excel (including use of functions and pivot tables) and PowerPoint software
- Demonstrated ability to work with effectively with multiple different areas within an organization (both internal and external)
- Proven ability to work effectively both independently and with teams in a dynamic and fast paced environment
- Proven leadership/strategy and organizational skills are required, as well as excellent written and verbal communication skills
- Strong interpersonal and communication skills and ability to work effectively with a wide range of constituencies
- Experience with healthcare operations, systems, and financial/claims data analysis
Environmental Job Requirements and Working Conditions- Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868.
- The annual total compensation target pay range for this role is: $175,000 - $185,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
